The Public Health Burden of Antimicrobial Resistance in Yemen: A Narrative Review

Background and Aim: Antimicrobial resistance is a global health crisis, with its impact magnified in conflict settings like Yemen, where a decimated health system and humanitarian emergency create ideal conditions for the proliferation of resistant pathogens. A clear understanding of the antimicrobial resistance landscape is essential for effective public health interventions. This communication synthesizes and critically appraises peer-reviewed studies and strategic reports published between 2019 and 2025 to delineate the status of antimicrobial resistance and antibiotic stewardship in Yemen, identify evidence gaps, and propose context-specific recommendations. Methods: A systematic search of PubMed, Google Scholar, Dimensions.ai, Semantic Scholar, and WHO regional publications was conducted for relevant literature from 2019 to 2025. Key data on study design, resistance patterns, antibiotic consumption, and knowledge, attitude, and practice were extracted and thematically synthesized. This review critically assesses the evidence base without introducing new primary data. Results: Localized surveillance indicates concerning resistance rates among key pathogens. Investigations conducted in Aden and Al-Bayda demonstrate elevated resistance to first-line antimicrobial agents, including trimethoprim-sulfamethoxazole and amoxicillin-clavulanate. Antibiotic utilization is notably excessive, particularly within intensive care units, with substantial dependence on "Watch" category antibiotics like ceftriaxone and last-resort drugs such as meropenem. A significant knowledge-practice discrepancy persists; although there is sufficient awareness regarding antimicrobial resistance, self-medication remains widespread (62.7% of the population), facilitated by the availability of non-prescription dispensing. The primary obstacle to the rational use of antibiotics is the high cost of diagnostic testing. Conclusion: Antimicrobial resistance in Yemen is a crisis driven by systemic collapse, not merely knowledge deficits. Effective interventions must be conflict-adapted, prioritizing subsidized diagnostics, redesigning awareness campaigns to address behavioral drivers, and integrating AMR containment into all humanitarian health responses.